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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000755
Report Date: 11/16/2021
Date Signed: 11/16/2021 03:49:31 PM

Document Has Been Signed on 11/16/2021 03:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:E & J GRIFFIN FAMILY CARE HOMEFACILITY NUMBER:
577000755
ADMINISTRATOR:GABRIELA ECHEVARRIAFACILITY TYPE:
735
ADDRESS:106 CASELLI CTTELEPHONE:
(530) 795-5938
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 6CENSUS: 3DATE:
11/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:June Penny, AdministratorTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at E & J Griffin Family Care Home on November 16, 2021 at approximately 2:45 to conduct an annual inspection focusing on Covid-19 Infection Control practices.

LPA was met at the door by June Penny, Administrator. LPA was screened and temperature taken before entry into the facility. All visitors, essential visitors, and staff are screened upon entry; temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Residents are screened and observed for any changes three (3) times a day, all information is logged. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored locked making them inaccessible to residents and staff that do not handle medications.

There are three (3) residents at the facility; two of the three are diagnosed with Prader-Willi Syndrome so access to the kitchen is limited to staff, but snacks and meals are served on a predictable schedule for the residents.

The facility was a comfortable temperature. The water temperature was 119.4 F.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the Administrator.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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